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- Select Provider – List is populated by master referring provider table
- Assign provider – Adds selected provider to list and brings up detail entry tool.
- Add referring provider – Add a referring provider to the master referring provider table from this screen
- Main – Only one entry can be main. When marked main the referring provider inforamtion will be included in box 17 of the CMS 1500
- Referring Provider
- Qualifier – Included in box 17 of CMS 1500
- Referral Date
- Referring Reason
- Edit Record
- Delete Record